NPI | 1417010323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE00005149) |
Additional Taxonomies | 122300000X Dentist (Licence: ID D3098) |
Enumeration Date | 2006-12-19 |
Last Update Date | 2021-11-03 |